Urology Book

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Intracorporal Prostaglandin E1

Aka: Intracorporal Prostaglandin E1, Intracorporal Alprostadil, Caverject
  1. Indications
    1. Psychogenic Impotence
    2. Neurogenic Impotence
    3. Vasculogenic Impotence
  2. Contraindications
    1. Penile deformity (e.g Peyronie's Disease)
    2. Priapism risk
      1. Sickle Cell Disease or Sickle Cell Trait
      2. Leukemia
      3. Multiple Myeloma
      4. Polycythemia Vera
      5. Thrombocythemia
      6. Anticoagulant use
  3. Mechanism: Corporal smooth muscle relaxation
    1. Increases arterial inflow
    2. Decreases venous outflow
  4. Preparations: Intracorporal Injection
    1. PGE1 or Alprostadil (Caverject)
      1. See also Intraurethral Alprostadil (MUSE)
    2. Papaverine
    3. Phentolamine
    4. Combinations: Alprostadil + papaverine + phentolamine
      1. May be more effective with less pain
  5. Dosage Alprostadil (titrate in physicians office)
    1. Dose
      1. Start: 2.5 ug (1.25 ug in neurogenic Impotence)
      2. Next: 5 ug
      3. Increase: 5 ug increments
    2. Endpoint
      1. Erection adequate for intercourse (duration <1 hour)
      2. Maximum reached (see below)
    3. Maximum dosing
      1. Maximum dose: 60 ug
      2. Do not exceed more than 3 times per week
      3. Do not exceed more than once in 24 hours
  6. Technique:
    1. Inject at dorso-lateral aspect in penis proximal third
    2. Alternate sides and sites for each injection
  7. Adverse Effects of Intracorporal Injection (41%)
    1. Hematoma
    2. Prolonged Erection exceeding 4 hours (4%)
      1. Patients should seek emergency attention for Erection lasting more than 4 hours
    3. Priapism with Erection exceeding 6 hours (1%)
      1. See Priapism Reversal Protocol
    4. Penile Plaques (10%)
    5. Penile fibrosis (5%)
  8. Efficacy (Caverject)
    1. Injectable alprostadil is more effective than Intraurethral Alprostadil
    2. Success Rates: 67 to 85%
    3. Compliance
      1. Discontinued therapy after 1 year: 56%
      2. Discontinued therapy after 2 years: 68%
  9. References
    1. Viera (1999) Am Fam Physician 60:1159-72 [PubMed]
    2. Sundaram (1997) Urology 49:932-5 [PubMed]
Medication Costs
caverject (on 6/1/2017 at Medicaid.Gov Pharmacy Drug pricing)
CAVERJECT 20 MCG VIAL $87.46 each
CAVERJECT 40 MCG VIAL $114.32 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Caverject (C0591238)

Concepts Eicosanoid (T111) , Pharmacologic Substance (T121)
MSH D000527
English caverject, Caverject, Pharmacia Brand 2 of Alprostadil, Sugiran
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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